KFF Health News January 9, 2024
There’s the Idaho doctor whose infant daughter developed a brain tumor. A woman in Southern California who waited months for an MRI before dying in the hospital. And a North Carolina patient who has trigeminal neuralgia — a condition so painful it’s commonly called the “suicide disease.”
They all have something in common, aside from a nightmare diagnosis. Their insurance companies, at some point, denied doctor-recommended care through a process called prior authorization — a set of rules, unique to every health insurance plan, requiring preapproval for some tests, procedures and prescriptions. Sometimes it’s called preauthorization; sometimes precertification. Regardless, prior authorization is almost universally despised by doctors and patients.
In 2021, Medicare Advantage insurers processed an average of 1.5...
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